Hepatic thrombus. Timely treatment of hepatic vein thrombosis

Despite the fact that thrombosis of the liver veins is distinguished by specialists as a separate group of diseases, nevertheless, it usually occurs against the background of an already long-term chronic disease. The impetus for it can be such severe pathologies like cirrhosis, oncological diseases liver or pancreas, pancreatitis. Causes can also be factors such as a thrombus or embolus carried by blood flow from another organ, the general venous insufficiency, cardiac pathology vascular system.

Clinical picture of liver thrombosis

The patient in this case requires immediate medical attention. Otherwise, almost immediately it will begin to form venous congestion, which, especially with complete blockage of the vessel, can lead to very serious consequences, up to lethal outcome. Thrombosis of the liver has a mild clinical picture, as its symptoms may resemble those of other diseases. It begins with severe abdominal pain, usually localized in the right side. The patient is very anxious. There is an increasing heaviness in abdominal cavity due to venous congestion in the liver and spleen. The tissues of the organs swell, stretch and there is severe swelling with the release of intracellular fluid, which is why ascites is formed. Because the arterial blood continues to flow to the liver and spleen, their capsule can break and separate vessels begin to burst, resulting in heavy bleeding from the esophagus. Also characterized by the presence of vomiting with abundant inclusion dark blood. Intoxication of the body with cellular decay products begins.

In some patients, a chronic course of liver thrombosis is observed in the case when the thrombus does not completely block the blood flow and the liver continues to be supplied with blood, although venous congestion in it gradually increases. This condition can continue for several years and end in very serious complications and even death of the patient.

Diagnosis of liver thrombosis

Thrombosis of the liver with timely application for medical care and correctly diagnosed, it is completely curable. However, the person suffering from them will have a long and difficult recovery. Diagnosis in this case, as already mentioned, requires special care. First of all, it is recommended to conduct Doppler ultrasonic scanning in three- and four-dimensional resolution so that the doctor has the opportunity to fully present the picture of everything that happens in the patient's body. This procedure allows you to clearly see the circulatory system of the liver, as well as the place affected by the thrombus. Four-dimensional resolution allows the specialist to predict how the clot will behave in the future and whether it has a tendency to detach and further move through the bloodstream.

Shown in this case and angiography of the liver. She represents X-ray examination using a specific dye that is injected into the hepatic vessels. The place where the bloodstream stops staining and there is a site of localization of the thrombus. After this area was identified, the catheter through which the doctor injected contrast agent, you can immediately enter a thrombolytic to dissolve the clot.

Endoscopic retrograde cholangiohepatography will not only allow to identify the place of vessel overlap in the liver, but also to get ahead of the nature of a thrombus or embolus. It also makes it possible to assess the general condition of the gastrointestinal tract and diagnose the general condition of the liver and the causes of the current chronic disease leading to thrombosis. The study will allow you to see the structure of the altered tissue, to identify the degree of expansion and possible gaps vessels, as well as assess the prospects for further treatment.

A necessary research method is magnetic resonance angiography, which also involves the use of dyes introduced into the bloodstream of the liver. These modern methods diagnostics will make it possible to identify the root causes that led to liver thrombosis, and therefore, begin the treatment of these diseases for the patient's overall recovery and return to full working capacity.

Treatment of liver thrombosis

Our medical center has been successfully treating liver thrombosis for a long time. We have:

. operating room equipped with everything necessary;
Well-equipped comfortable hospital;
We employ excellent specialists, experienced professionals who practiced in the best clinics cities and carried out the most complex operations.

It is likely that the patient will need therapeutic treatment, and surgery, and a long course of taking special medications. If the thrombus could not be removed immediately with thinners medicines, then to facilitate general condition an operation is performed to create bypass routes for venous hepatic outflow. The patient's well-being improves dramatically and against this background it is already possible to carry out complex treatment. In the postoperative recovery period a number of drugs are prescribed to prevent excessive blood clotting and new thrombosis. In addition, the patient is prescribed hepatoprotectors to improve the functioning of the liver.

AT rehabilitation period the patient must be under constant surveillance doctor to monitor the restoration of normal venous blood supply, monitoring the risk of new blood clots, the state of the surrounding abdominal organs. In addition, you should start immediate treatment from the disease that served as an impetus for the development of hepatic thrombosis. Therefore, the patient should regularly go to our medical center examination by a gastroenterologist, hepatologist and surgeon.

With the blood entering the portal vein system, the liver also receives oxygen and nutrients.

Thrombosis of the portal vein or pilethrombosis is characterized by the formation of a parietal thrombus, which completely or partially blocks the lumen of the vessel. Impaired blood flow in the liver and gastrointestinal tract develops portal hypertension and cirrhosis. For many years, the disease was considered rare, but with the improvement of diagnostic methods that allow visualization of the blood flow pattern, pylethrombosis is often detected in patients suffering from cirrhosis of the liver.

The reasons

According to modern classification, the causes of portal vein thrombosis are usually divided in the following way:

local (inflammatory processes in the abdominal cavity, damage to the portal vein as a result of injuries, medical manipulations);
systemic (thrombophilia - clotting disorders with a tendency to thrombosis, - hereditary and acquired nature).

Indirect causes of hepatic vein thrombosis are malignant neoplasms in the liver and decompensated cirrhosis. There are also risk factors that increase the likelihood of the disease - pancreatitis, cholecystitis and others. inflammatory diseases abdominal organs, especially if surgery is involved in their treatment.

Clinical picture

According to the nature of the course, thrombosis of the portal vein of the liver can be acute and chronic.

Acute thrombosis is manifested by such signs:

severe abdominal pain that comes on suddenly
increased body temperature, constant fever;
nausea, vomiting, stool disorder;
splenomegaly (enlargement of the spleen).

These symptoms of portal vein thrombosis manifest simultaneously, sharply worsening the patient's condition. A dangerous complication is intestinal infarction, i.e., necrosis of its tissue when mesenteric veins are blocked by blood clots.

The chronic variant may be asymptomatic. In this case, portal vein thrombosis is an incidental finding in studies performed for other abdominal pathologies. The absence of manifestations is the merit of compensatory mechanisms. Among them is vasodilation (expansion) hepatic artery and the development of a cavernoma - a network of venous collaterals (additional veins that take on an increasing load). Only when the ability to compensate is depleted, characteristic symptoms appear:

General weakness, lethargy, lack of appetite.
Syndrome portal hypertension:
- ascites (accumulation of fluid in the abdominal cavity);
- expansion of the saphenous veins of the anterior wall of the abdomen;
- varicose veins veins of the esophagus.
Sluggish form of pylephlebitis (inflammation of the portal vein):
- dull pain in the abdomen of a permanent nature;
- subfebrile body temperature (37–37.5 degrees Celsius) for a long time.
Hepatosplenomegaly ().

most likely and common complication- Esophageal bleeding, the source of which are varicose veins. progresses chronic ischemia(circulatory failure) and subsequent cirrhosis (replacement connective tissue liver cells), if it was not present before, having played a role in the development of the pathological process.

Diagnostics

Imaging techniques are used to confirm the diagnosis:

Ultrasound of the abdominal organs, dopplerography ( ultrasound procedure portal vein);
computer and magnetic resonance imaging of the abdominal organs;
angiography of the portal vein (X-ray examination with the introduction of a contrast agent);
splenoportography, transhepatic portography (contrast injection into the spleen or liver);
portal scintigraphy (introduction of a radiopharmaceutical and fixation of its accumulation in the portal vein).

Treatment

The therapy strategy includes several components:

Anticoagulants (heparin, pelentan). They prevent the formation of blood clots and promote recanalization (restoration of patency) of the vessel.
Thrombolytics (streptokinase, urokinase). The indication is portal vein thrombosis, the treatment of which, in fact, is to eliminate the thrombus blocking the lumen.
Surgical treatment (transhepatic angioplasty, thrombolysis with intrahepatic portosystemic shunting).
Treatment of complications - bleeding from the veins of the esophagus, intestinal ischemia. It is carried out in an operative way.

Currently under development effective method thrombosis prevention. As such a means, the method is proposed non-selective beta blockers(obzidan, timolol).

Forecast

The prognosis of portal vein thrombosis largely depends on the degree of disorders that have occurred in the body. An acute episode with failure of thrombolysis requires surgical treatment that in itself is a risk. Chronic thrombosis manifests itself in the form of complications when the process has gone far enough in its development, and its treatment begins with emergency care. The prognosis in these cases is doubtful or unfavorable. Probability successful treatment raises timely diagnosis thrombosis on early stages when compensation mechanisms are able to delay the onset of irreversible changes.

Thrombosis of the hepatic veins (Budd-Chiari syndrome) - acute disorder blood circulation in blood vessels liver. The overlap of the lumen can be complete or partial, this causes clinical manifestations pathological condition. It is more common in the elderly, but can also be diagnosed in young people.

Why does

The main cause of the development of pathology is a thrombus in the liver, as a result of which the free flow of blood is disturbed. Various factors can provoke the formation of a clot:

disorders of hemostasis in diseases of cardio-vascular system (increased clotting blood and a tendency to thrombosis);
hemolytic anemia, accompanied by accelerated destruction of red blood cells in the liver;
deep vein thrombophlebitis, pericarditis, peritonitis;
blunt abdominal trauma (damage to the abdominal organs);
systemic autoimmune and infectious diseases(lupus erythematosus, tuberculosis, syphilis, etc.);
neoplasms in the pancreas, liver, kidneys, adrenal glands;
long-term use medications (hormonal contraceptives, glucocorticosteroids, etc.);
genetic predisposition.

In children, the onset of the disease can be triggered by congenital narrowing of the veins, infection of blood vessels through the umbilical cord, and a postoperative complication.

Symptoms

Hepatic vein thrombosis may be acute or chronic. Symptoms depend on the degree of blockage in the lumen of the blood vessel.

Signs of an acute condition:

sharp pain in the abdomen;
nausea;
vomit;
stool disorder (diarrhea);
fever, chills, weakness, sweating;
an increase in the size of the liver and spleen.

With incomplete occlusion develops chronic insufficiency circulation in the liver. At the initial stage of the disease clinical symptoms missing. This is due to the activation of the compensatory collateral circulation, thanks to which oxygen and nutrients enter the tissues in a circular way.

Weakness and lethargy gradually increase, appetite worsens, signs of portal hypertension appear (increased pressure in the portal vein system). The main manifestations are the development of ascites, an increase in the size of the veins of the anterior abdominal wall, varicose veins of the esophagus, etc. This threatens to rupture blood vessels and develop bleeding.

Chronic inflammation of the portal vein (pylephlebitis), in which there is a narrowing of the vessel along its entire length, is accompanied by constant aching pains in the abdomen, prolonged subfebrile condition. The spleen and liver gradually increase in size, which extends beyond the edge of the costal arch. Increasing tissue ischemia, which provokes a violation of the functioning of hepatocytes. As a complication, hepatitis and cirrhosis of the liver develop.

Diagnostics

Diagnosis of liver thrombosis is extremely difficult. This is due to the absence of specific signs of the disease. The symptoms present may indicate many other pathologies.

Main research methods:

Doppler ultrasound. It makes it possible to detect clots in the blood vessels of the liver, to establish the degree of blood flow disturbance, the nature of blood clots (soldered to the walls or free).
Angiography. Intravenous administration of a special radiopaque agent. After that, a series of pictures is taken, on which it is possible to detect areas where the blockage of the vein has occurred. If a similar problem occurs not for the first time, along with a radiopaque agent, drugs are simultaneously administered to dissolve blood clots.

From others additional ways use magnetic resonance imaging, the use of radionuclides, general clinical and biochemical analyzes blood.

Treatment

Thrombosis of the hepatic vessels requires complex treatment. On the initial stages pathology, the use of medications is sufficient; in severe cases, surgical intervention is indicated to eliminate occlusion.

Medications

In the treatment of thrombosis, drugs are used to restore normal rheological properties blood, activation of blood flow and elimination of the causes that provoked the development of the disease.

For this use:

Anticoagulants (Clexane, Fragmin, etc.). They inhibit the formation of fibrin filaments, from which clots are subsequently formed. Prevent an increase in the size of existing blood clots, activate natural processes aimed at breaking them down.
Diuretics. They help to remove edema, which are the result of thrombosis. For this purpose, Spironolactone, Furosemide, Veroshpiron, Lasix, etc. are used.
Thrombolytics (Urokinase, Alteplase, Actilyse, etc.). Promote the dissolution of clots, thus restoring free blood flow. The use of thrombolytics is indicated in the initial stages of the development of the disease.

In addition, with increased blood pressure use antihypertensive drugs, with varicose veins and circulatory disorders - venotonics.

Surgery

With the development of acute occlusion, as well as if the Budd-Chiari syndrome is caused by a tumor in the liver, kidneys or pancreas, removal of the formation is indicated. In some cases, a liver transplant may be needed.

With a decrease in the lumen of the inferior vena cava associated with chronic inflammation or education atherosclerotic plaques recommended angioplasty. A stent is then placed to keep the vein wide enough to prevent it from collapsing.

Shunting will help reduce the pressure in the sinusoidal spaces. This method is indicated for the formation of blood clots in the inferior vena cava.

Everyone knows that blood flows from the organs through the veins. But in our body there is an exception. It's about the portal vein. It is formed by 2 mesenteric and one splenic vein. Collects blood from the digestive tract, then enters the liver.

Portal vein thrombosis is dangerous state when a thrombus forms in the lumen of a vessel. Accordingly, the blood flow is disturbed.

The reasons

The disease can develop not only in adults. Even babies are at risk. Portal vein thrombosis is a complication of infection of the umbilical cord stump. Acute appendicitis can also provoke the development of serious consequences.

Consider the main causes of portal vein thrombosis. The German scientist Rudolf Virchow found that in order to implement this disease 3 conditions are required.

Violation of the integrity of the vascular wall. Namely, the endothelium. If the surface does not pathological changes, formed clots move with the blood flow. But in case of injury or inflammatory processes the structure of the endothelium changes. The formed clots settle in these places, gradually accumulating. As a result, an obstruction of the vessel occurs.

Surgical interventions.
Phlebitis.
Arteritis.

Increased blood clotting. The disease can be either genetically determined or acquired.

Etiological factors:

Congenital pathologies (protein S deficiency, antithrombin deficiency, protein C deficiency, antiphospholipid syndrome, hyperhomocysteinemia).
Oncological diseases.
Taking oral contraceptives.
Anticancer drugs.

Increased clotting is also observed in pregnant women. postpartum period also at risk for developing hypercoagulability. This is explained by physiologically substantiated processes: the level of procoagulant factors increases and anticoagulant activity decreases.

Decreased blood flow.

Heart failure.
Pre- and postoperative long-term immobilization.
Passive lifestyle.
Long distance flights.

Main manifestations

expressiveness clinical picture, based on which the doctor can diagnose portal vein thrombosis, depends on the course of the disease (acute or chronic), the localization of the thrombus and the length of the pathological focus.

If a acute course, compensatory mechanisms fail to work on time. In the case of combined thrombosis of the portal and mesenteric vein outcome can be fatal.
At chronic course the changes increase gradually. Collateral blood flow takes over the functions of the lost area. The prognosis is more favorable.

signs

portal hypertension.
Enlargement of the spleen.
Bleeding from dilated veins of the esophagus. At the same time, patients complain about severe pain, black chair. Perhaps the development of vomiting "coffee grounds".
Pain in the intestines, flatulence, intoxication phenomena. The reason for this is paralytic ileus intestines as a result of the lack of blood flow through the mesenteric veins.
Liver enlargement, soreness, chills. Occurs due to purulent pylephlebitis.
Jaundice of the face, sclera.
As a result liver failure encephalopathy may develop.

It should be noted that a heart attack develops not only in the heart muscle. Occlusion of the lumen of the mesenteric vein leads to serious complication- intestinal infarction. And he, in turn, causes peritonitis.

Examination of the patient

For the purpose of diagnosis, both laboratory and instrumental methods research. Let's consider them in more detail.

In the first place, of course, is the ultrasound. The doctor checks not only the lumen of the portal vein (after the injection of a contrast agent), but also the condition of the liver and all organs digestive system. There are cases when it is necessary to conduct a comprehensive examination to identify the root cause. Sometimes during the examination it is possible to detect liver diseases (cirrhosis, malignant neoplasm- hepatocellular carcinoma).
When conducting a coagulogram, thrombosis is indicated by the following signs:

Elevated fibrinogen levels.
Increase in PTI (prothrombin index).
Decreased clotting time.

Angiography. Main instrumental research, confirming not only the diagnosis of “portal vein thrombosis”, but also allowing to identify the exact localization of the thrombus, the extent and even the speed of blood flow both in the portal vein and in the hepatic and porto-caval vessels. This is done in the following way. A contrast agent is injected into the portal vein. On the monitor of the x-ray machine, the uniformity of blood flow is studied.
With the help of CT and MRI, it is possible to identify not only a blood clot, but it is also possible to fix associated pathological signs. Namely: varicose expansion of porto-caval anastomoses, ascites (accumulation of fluid in the abdominal cavity), enlargement of the spleen.

Treatment

First of all, appoint drug therapy. The treatment regimen for patients with a diagnosis of portal vein thrombosis includes:

thrombolytic agents. Fibrinolysin is administered intravenously (using droppers).
Anticoagulants indirect action. Neodicoumarin, Sincumar.
Reopoliglyukin to replenish the required volume of circulating fluid.
Antibiotics are prescribed for the development of purulent complications.

An ambulance for thrombosis is Heparin (Fraksiparin). This drug belongs to the group of direct-acting anticoagulants. Apply in the first hour of the development of signs of the disease.

If during conservative treatment there is no positive dynamics, they resort to surgical intervention. The task of the latter is to recreate collaterals to restore blood flow. As a rule, impose splenorenal anastomosis.

Thrombosis of the portal vein can cause the development of intestinal infarction, peritonitis, massive bleeding, renal and hepatic failure. Therefore, when identifying the first signs, you should consult a doctor. This way you can avoid dangerous complications without resorting to surgical intervention.

Thrombosis is considered one of the most dangerous diseases vascular system, and the appearance of blood clots both in the veins and in the arteries poses a threat to life. A blood clot that appears in any part of the body can eventually become an embolus - “traveling” along circulatory system a thrombus that can clog a vital artery and provoke the death of a person. Most often, people have thrombosis in the lower and upper limbs. But sometimes thrombosis covers the veins internal organs which is much more dangerous and more difficult to diagnose and treat. Portal vein thrombosis is one of the most severe in the group similar diseases, and by many experts it is recognized not as an independent pathology, but as a complication of other problems in the body.

Features of the disease

The portal vein in the peritoneum forms a large system, and along its branches deoxygenated blood from part of the gastrointestinal tract, pancreas, spleen, gallbladder. The portal vein itself is formed from the junction of the superior mesenteric vein and the splenic vein. Its duration to the gate of the liver is 6-8 cm, and then it is divided into the left, right lobar branch in the lobes of the liver. Within the liver, these branches divide into segmental branches that run adjacent to the hepatic artery.

Thrombosis of the portal vein is the process of formation of a thrombus in the hepatic veins up to complete blockage of the lumen of the vessel - the main trunk of the vein or its branches. The disease is characterized by a progressive course, accompanied by severe violation blood flow in the liver and small intestine. Another name for a blood clot in the liver is pilethrombosis. For the first time, such a diagnosis was made to his patient by S.P. Botkin back in 1862, and later research data were collected and the main causes and symptoms of the pathology were described.

Portal vein thrombosis is not often diagnosed in medicine, being considered a rather rare pathology. It may be a consequence huge amount conditions and disorders, both occurring in the body and surgical interventions. The insidiousness of the disease lies in its long asymptomatic course, which makes it difficult early diagnosis and start of treatment. With cirrhosis of the liver, pylethrombosis develops in 20-40% of cases, and with liver transplantation - in 2-20% of cases.

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The classification of the disease includes its types according to the localization of the thrombus:

radicular thrombus - occurs in the vein of the stomach, spleen, mesentery, penetrates into the portal vein;
truncular thrombus - appears in the main trunk of the vein;
intrahepatic (terminal) thrombus - develops inside the liver.
According to the time of development of pathology, it is differentiated into:
Acute pylethrombosis - occurs suddenly, develops at lightning speed, entails death in 99% of situations due to necrosis and death of the stomach, pancreas, intestines, liver, spleen.
Chronic pyletrombosis - flows slowly, while a complete cessation of blood flow does not occur. The thrombus partially blocks the lumen of the vessel, and blood from the peritoneal organs begins to flow around the portal vein through the system of the inferior vena cava.

Causes

In newborns, symptoms of portal vein thrombosis may be associated with infection of the umbilical stump, when infectious particles pass through the umbilical vein into the portal vein. In the older childhood the causes of the disease are severe course acute appendicitis when microbes enter the vein, infecting it and causing inflammation (phlebitis) and vessel thrombosis. A risk factor for the development of pilethrombosis in children is congenital anomalies in the structure of the vein.

In adulthood, up to 50% of cases of portal vein thrombosis remain unknown as to the cause of their occurrence.

Remaining registered clinical cases Pilethrombosis is usually associated with the following conditions:

surgical intervention on the peritoneum, especially often - splenectomy;
trauma, injury of the vein wall;
hypercoagulation syndrome;
tumor of the pancreas, squeezing the vein;
cirrhosis of the liver;
liver carcinoma;
echinococcal cysts in the liver;
alveococcosis of the liver;
multiple pregnancy, complications of pregnancy and childbirth, in particular, eclampsia;
Baada-Chiari syndrome;
pancreatic necrosis;
purulent complications of appendicitis, especially peritonitis;
purulent cholangitis;
ulcerative colitis;
lymphadenitis of the hepatoduodenal ligament;
chronic heart failure;
endocarditis;
diseases accompanied by a serious increase in blood viscosity;
syphilis;
heavy infectious diseases- malaria, Ebola, etc.

Symptoms of thrombosis

Clinical manifestations will depend on the rate of development of the disease, the size of the thrombus and the extent of the thrombosis, as well as on which pathology or condition caused the pylethrombosis. The most common symptoms of this disease in its acute form are as follows:

sharp, sudden pain in the epigastrium;
bloating, progressing literally before our eyes due to the accumulation of fluid in the peritoneum;
expansion of the subcutaneous venous network;
recurring vomiting, including bloody;
bleeding from the rectum;
jaundice;
swelling of the lower extremities;
rapid development of diffuse peritonitis;
numerous bleedings, heart attacks on the background of organ ischemia;
death can occur within a couple of days (more typical for stem thrombosis).

In the vast majority of cases, portal vein thrombosis has a sluggish course and becomes chronic. At chronic development pathology, splenomegaly, permanent or transient ascites of the peritoneum, weakness, weight loss, lack of appetite, regular abdominal pain can be observed. There is also a constant subfebrile increase in body temperature, moderate leukocytosis, a slight increase in the liver and its tuberosity, pain in the palpation of the abdomen. With absence correct diagnosis at the stage of progression of chronic pylethrombosis, it is often missed until the moment when it is no longer possible to save a person.

A relatively favorable development of events also occurs - the appearance of collateral veins, which form in a few days, forming a cavernous vein. When diagnosed, it is often perceived as a tumor from the vessels, or as congenital anomaly development of this area of the body.

Such collaterals are capable of changing the form bile ducts, stomach, parts small intestine which further complicates the diagnosis. In addition, such changes in the body can provoke the development of jaundice and other complications. On average, chronic portal vein thrombosis can last from a couple of months to a year.

Pilethrombosis is usually divided into stages:

the first - minimal thrombosis, overlap of no more than 50% of the vein, the blood clot is located above the area of transition of the portal vein into the splenic vein;
the second is the flow of a thrombus to the superior mesenteric vein;
the third - the defeat of all veins of the peritoneum with partial preservation of blood flow;
fourth - massive thrombosis, serious breach blood flow and blood supply to internal organs.

Possible Complications

Pilethrombosis is very serious illness, dangerous both in itself and in its complications. In the absence of the development of vascular collaterals, the blood supply to the intestines, liver and other organs cannot be carried out. The result is ischemia followed by necrosis. The consequence is peritonitis, multiple organ failure, liver abscess, hepatic coma, extensive intestinal, stomach bleeding, subrenal abscess. Any of these diseases can lead to death.

One of the options clinical development is a purulent fusion of a thrombus and the transition of the disease to a complicated form - pylephlebitis (pylethrombophlebitis). Inflammation in this pathology quickly passes to all branches of the hepatic vein, resulting in the formation of multiple liver abscesses. Without emergency massive antibiotic therapy and surgical removal abscesses, this disease also ends in death.

Carrying out diagnostics

To make a diagnosis, you need to the following types surveys:

coaulogram (an increase in fibrinogen is detected, a decrease in blood clotting time);
complete blood count (fall in red blood cells, increase in white blood cells, decrease in hemoglobin);
CT and ultrasound (detected collateral vessels, ascites, varicose veins, abscesses in the liver and other changes in the internal organs, including an enlarged spleen);
angiography (a method that allows you to find a blood clot in the portal vein, to establish its size, shape, blood flow velocity);
liver biopsy and laparoscopic examination (the disease should be suspected in all cases of portal hypertension, but in the absence of pathological findings from a liver biopsy).

According to ultrasound data, in case of portal vein thrombosis, the diameter of the vessel is increased to 13 mm. and more, the echogenicity of the liver increases. Illness in chronic form often mistaken for chronic appendicitis, chronic cholecystocholangitis and others inflammatory diseases internal organs. As a rule, only after long-term observation and detection of collaterals, the diagnosis is finally confirmed.

Treatment Methods

In newborns and children, urgent treatment of the underlying disease that caused portal vein thrombosis should be carried out. This includes removal of the appendix, other sources of infection, antibiotic therapy. In chronic pylethrombosis, it is often carried out first conservative treatment, or it is carried out after a splenectomy - removal of the spleen. medical appointments with chronic portal vein thrombosis, they can be:

Exclusion of any physical activity and abdominal trauma.
Injection of small doses of epinephrine under the skin to contract the spleen and release excess blood from it.
Intravenous administration of antibiotics.
With bleeding - the introduction of vitamin K, rutin, calcium chloride, complete peace. Use for severe bleeding intravenous administration b-blockers.
With bleeding from the esophagus - the introduction of a special balloon into it and its inflation in combination with drug therapy.
Puncture of the peritoneum and removal of fluid from it in ascites.
Anticoagulant therapy to prevent the formation of new blood clots (in the absence of bleeding). Heparin, fraxiparin are used intravenously.

At acute thrombosis portal vein system emergency surgical treatment in combination with anticoagulant therapy, which is necessary to prevent intestinal infarction. Surgery, its type and extent of coverage of the peritoneum will depend on the location of the thrombus and the cause that caused the disease. Thrombolysis is performed using transhepatic access, transhepatic angioplasty, intrahepatic portsystemic shunting, thrombectomy with the introduction of fibrinolytic and other types of operations (according to indications). In the chronic form of the disease, the same types of operations are carried out in a planned manner.

Forecast and prevention

A favorable outcome is observed in the presence of small blood clots that can completely resolve. Also, large blood clots can be covered with connective tissue, which later replaces the entire thrombus and forms channels and slots in it for blood flow (thrombus sewerage). As a result, normal blood flow is restored and severe consequences does not occur for the organism. Unfortunately, portal vein thrombosis has a higher incidence of poor outcomes. In particular, they can be caused by thrombus embolism, its septic melting. In general, the 10-year survival rate for pylethrombosis reaches no more than 40-50% (meaning chronic and subacute form disease), which largely depends on the cause of the disease. With acute blockage of the portal vein, the survival rate of patients tends to zero.

Prevention measures for this pathology are as follows:

transition to proper nutrition;
additional intake of vitamins;
consumption enough liquids;
regular physical activity;
hiking;
timely treatment of all diseases of internal organs;
preventive visits to general and narrow specialists.

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